Stig Östlund

torsdag, september 05, 2013

Från veckans NEJM





http://www.nejm.org/doi/full/10.1056/NEJMra1203528?query=TOC



(...) The hazardous effects of smoking on mortality from cancers and cardiovascular and respiratory diseases have been known for decades. (...)

(...) Alcohol consumption is associated with numerous diseases and injuries. Moderate alcohol consumption has been inversely associated with the risk of cardiovascular diseases and diabetes, although the benefits may be greater for persons with existing cardiovascular risk factors than for those without such risk factors. Epidemiologic studies that have measured both the amount and patterns of alcohol consumption have shown that heavy episodic (or binge) drinking not only substantially raises the risk of injuries but can also increase the risk of or exacerbate cardiovascular disease and liver disease.(...)

(...) Numerous observational studies in Western and Asian populations have associated different measures of adiposity and excess body weight with increased total mortality and increased risks of disease or death from diabetes, ischemic heart disease and ischemic stroke, cancers, chronic kidney disease, and osteoarthritis. The risks of diabetes and ischemic heart disease increase monotonically with an increase in the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters), starting at a BMI in the low 20s (...)

(...) Centuries after the effects of specific dietary intakes on conditions such as scurvy were discovered, nutritional epidemiology has established the associations of specific foods and nutrients or overall dietary patterns with cancers, cardiovascular diseases, and diabetes and with intermediate outcomes such as weight gain, increased blood pressure, and insulin resistance and hyperglycemia. The large body of observational studies is increasingly complemented by well-designed randomized trials that have, for example, shown the benefits of lower salt intake, the replacement of saturated fats with polyunsaturated fats, and healthy dietary patterns. Low dietary intakes of fruits, vegetables, whole grains, or nuts and seeds or a high dietary intake of salt are individually responsible for 1.5% to more than 4% of the global disease burden (...)

(...) Studies of the beneficial health effects of physical activity date back to the 1950s4 and have been replicated in large cohorts. Physical activity at work, walking, and, in some populations, bicycling used to be major contributors to total energy expenditure but have declined dramatically in industrial and urban societies.(...)

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